The young woman didn’t know how she could afford to keep the pregnancy she hadn’t anticipated or prepared for as she neared the end of her first trimester.

Recently unemployed and barely getting by, she also wasn’t sure how to come up with the money for an abortion, the choice she deemed right given her tight finances and life circumstances.

The 24-year-old with red highlights woven in a long braid contemplated selling her television or one of the few other items in her one-bedroom apartment on the city’s South Side. She considered borrowing cash from family or friends but cringed at the imposition, which would likely require an explanation delving into her personal life and privacy.

“I don’t have any help,” she said, awaiting her appointment on a recent weekday at the Planned Parenthood of Illinois Near North Health Center in the Gold Coast neighborhood. “That’s why I’m making the decision I am now.”

The patient was surprised and relieved to learn state Medicaid would cover the cost of the roughly $500 procedure, the result of a controversial Illinois law that expanded taxpayer-subsidized abortions and went into effect Jan. 1.

“I didn’t know what I was going to do,” she said, asking to remain anonymous. “I’m thankful I was able to use the medical card because I don’t have the money right now.”

Even in a state considered a reproductive rights haven within the more restrictive Midwest, debate over House Bill 40 divided Illinois — just one battle in a decadeslong war over public funding for abortion that continues here and nationwide.

State officials had projected the cost at roughly $1.8 million annually, though no one could predict how many women would use the new law, which provides coverage for abortion for state employees and Illinois residents approved for Medicaid.

While it’s too soon to tally the annual cost or participation, women who’ve received assistance under the new law said its impact has been enormous.

Supporters urged its passage by donning red robes and white bonnets in a succession of “The Handmaid’s Tale” protests, a nod to the dystopian novel and TV series. Republican Gov. Bruce Rauner outraged his party’s conservative base by signing the legislation in September. Then in the March primary he narrowly defeated challenger Jeanne Ives, a state lawmaker whose televised campaign ad featured a young woman thanking the governor “for making all Illinois families pay for my abortions.”

Anti-abortion organizations and some Republican lawmakers filed a lawsuit to block the legislation; an Illinois judge dismissed the case but the plaintiffs have appealed.

“The fact that the government is using taxpayer money to fund abortion is reprehensible to me,” said Tim Moore, president of Springfield Right to Life, one of the plaintiffs. “I’m subsidizing an immoral act. I’m subsidizing the culture of death. The government, which is supposed to protect life, is willfully taking part in the slaughter of innocents.”

The young woman wasn’t aware of the new law until she called to schedule the procedure a few days prior.

For her and other low-income patients in the crowded clinic waiting room, the expanded coverage meant access to an abortion despite their economic constraints.

“Everybody doesn’t have the same privileges,” she said.

‘I felt all the pain’

Asking for help has always been hard.

“People will tell you, ‘Oh, keep the baby, an abortion’s not good,’” the young woman with the braid said wearily in one of the health center’s small counseling rooms. “But as soon as you don’t do it and your baby’s here, guess what, everybody disappeared. The baby’s here, and nobody’s going to actually help you at all.”

This was the case about two years ago when she gave birth to her daughter. The young mother scrolled through dozens of images on her phone of the grinning toddler, who already knows her numbers and letters.

“She’s very smart. She’s going to go far in life,” the single mom said. “By her having a strong mother in me … she won’t be alone. I need to provide for her like I’ve been doing, rather than bring somebody else until we’re all the way stable.”

They share their apartment’s only bedroom, sleeping in adjacent beds. There is no room for anyone else, she said.

The woman has had jobs at grocery stores and restaurants and is now searching for similar work. Her dream is to earn a culinary degree and become a chef, but she has no baby sitter or car or steady income.

Swelling and tenderness in her breasts were the first signs of the unplanned pregnancy, which was confirmed by an ultrasound at the clinic. Right away, she decided to terminate.

“It wasn’t a hard decision to make,” she said, “because I know what’s important. I know what I’m capable of doing and what I’m not capable of doing. It would be a bad idea to be really struggling more than I am right now.”

A few inches from her hand, a wicker basket displayed samples of various birth control devices — a vaginal ring, an IUD, an implant encased in plush material to simulate its texture under the flesh of an arm.

The young woman said she was ona contraceptive patch but conceived between applications when she had difficulty getting refills from the pharmacy.

About a year ago, she had another abortion at Stroger Hospital before the procedure was covered by Medicaid. The cost at the public hospital was $75.

“I had to go around asking for it,” she said. “And when you borrow money, people want to know what it’s for. … Then people look at you funny, like, ‘Oh, why are you doing this?’ You don’t want to involve people because they’re going to give their opinion and talk about you and spread it on to the next person.”

She came to Planned Parenthood this time because she wanted to be sedated during surgery, which is an option at their health centers but also increases the price. Patients terminating pregnancies at the county hospital are provided a local anesthetic for pain management but are not sedated during the outpatient procedure, according to county officials.

“I had to be woke, and I felt all the pain,” she said, shuddering at the memory. “It’s very sharp. … The pain is over quick, but you’re still not going to forget that pain.”

Stacey Wescott / Chicago Tribune

An exam room at Planned Parenthood in Flossmoor. Since the passage of HB40, women can now use Illinois Medicaid to cover abortion services.

An exam room at Planned Parenthood in Flossmoor. Since the passage of HB40, women can now use Illinois Medicaid to cover abortion services. (Stacey Wescott / Chicago Tribune)

Cook County, which operates Stroger, has its own tumultuous history of taxpayer-subsidized abortions.

In 1980, the county banned the procedure at the hospital except in cases endangering the life of the woman.

Referring to the county hospital as an “abortion mill,” then-Cook County Board President George Dunne cited a shortage of nurses and a state law that had barred the use of public assistance to fund abortions.

“It’s a matter of priorities,” Dunne had told the Tribune back then. “A woman who wants to pay for her abortion should go to a private hospital or doctor, but we shouldn’t be staffing (an abortion clinic at County Hospital) when we’re having to turn people away.”

At the time, an estimated 3,500 pregnancies were terminated there annually. The change was abrupt: The first day, 18 women who had already scheduled the procedure were denied, the Tribune reported.

Amid protests and litigation, abortion services were restored 12 years later under the leadership of a new county board president, Richard Phelan. More than 500 women called the first day the hospital began resuming appointments for the procedure in 1992, many facing a long waitlist.

“Every woman in this country has a legal right to an abortion,” Phelan had said. “By denying poor women access, we deprive them of their constitutional rights just as surely as if we refused to allow them to vote. We must level the playing field and right the wrong.”

‘I’ve got to see my other kids grow up’

A woman in a long dress pressed a heat pack to her belly on a recent afternoon at the Planned Parenthood of Illinois Flossmoor Health Center, which opened in January.

The 37-year-old was recuperating after a surgical abortion less than a half-hour earlier, and the numbness around her midsection was beginning to subside. She said she would have preferred a medication abortion but was just past the 10-week limit.

Her son, a 19-year-old college student, accompanied her to the clinic from their home in the south suburbs. Earlier, when she had offered him a cup of coffee or some breakfast, he declined, deciding that because she had to fast before the procedure, he would too. He told her he’d wait and they’d have lunch together after it’s over. She’s also raising a rambunctious 3-year-old daughter.

A chronic medical condition had been ailing her recently, and she was preparing to have an operation to treat it. For some 18 years she’d intermittently been on the injectable birth control Depo-Provera, but said she was recently taken off the contraceptive while on medication related to her health problems. That was when she conceived.

She said she feared having that operation while pregnant but was also scared to delay it.

“That’s why I came here today,” said the woman, who asked not to be named, “so I can get the abortion and have my surgery and get my health together first and take care of myself. … I’ve got to see my other kids grow up.”

She plans to have that operation, which is typically covered by Medicaid, as soon as possible. To her, both medical procedures are an equally appropriate use of public funding.

“A lot of people don’t have finances to come to the doctor. There’s a lot of stuff going on in the world,” she said. “It helps people that use it, that can’t afford it, that (are) in bad situations.”

She said she’s pursuing degrees in business management and computer technology, hoping one day to start a cleaning business.

The hundreds of dollars she saved on the abortion will help with utility bills and rent, she said.

“You never know what somebody’s going through,” she said. “It’s helpful to people. They shouldn’t take it away from people who need it.”

Opposition to government-subsidized abortion has deep historical roots in Illinois, despite its reputation as a stronghold for reproductive freedom.

After the landmark U.S. Supreme Court case Roe v. Wade legalized abortion nationwide in 1973, Medicaid paid for an estimated 300,000 procedures annually across the country, according to the nonprofit Center for Reproductive Rights.

Then Congress passed the Hyde Amendment in 1976 to bar the use of federal funds to pay for abortions, named for its sponsor U.S. Rep. Henry Hyde, then a relatively inconspicuous freshman congressman from the west suburbs. The amendment, implemented in 1977, has been reapproved in some form each year, now with exceptions in cases of rape, incest or to save the life of the woman.

“A fetus is not a chicken or a tumor or a bad tooth to be pulled out,” the late Hyde had told the Tribune in 1977, drawing parallels between abortion and a Nazi concentration camp. “It is a human being. Abortion is the calculated killing of an innocent but inconvenient human being. You know, I have never been able to divorce what happened in Dachau from what is happening in abortion clinics.”

The American Civil Liberties Union in the late 1970s said the Hyde Amendment had “virtually eliminated” the “constitutional right of poor women to secure safe abortions.”

Stacey Wescott / Chicago Tribune

A woman works in the lab at Planned Parenthood in Flossmoor in 2018.

A woman works in the lab at Planned Parenthood in Flossmoor in 2018. (Stacey Wescott / Chicago Tribune)

State governments, however, can choose to expand the circumstances under which the state portion of Medicaid funds abortion.

Thirty-two states now follow the federal standard. South Dakota law is more stringent, only paying to terminate pregnancies in cases where the woman’s life is in danger. Seventeen other states have laws that allow Medicaid to be used beyond the federal exemptions; a dozen of them do so under court order and another five are voluntary, according to the Guttmacher Institute, a research organization that supports abortion rights.

‘One less burden’

At the Flossmoor clinic, health center manager Nicole Herron said searching for funding can sometimes delay an abortion, a time-sensitive service that gets more arduous and expensive the further along the pregnancy.

“It adds more stress to it because you’re already dealing with these emotions of this type of decision that you’re making,” she said. “To know that I’ve made this decision, this is what’s best for me, and now I can’t get it because I can’t pay for it.”

Not everyone who’s struggling financially qualifies for Medicaid, and women traveling from other states aren’t eligible, so the new law doesn’t eliminate all economic barriers to abortion, she added.

Herron recalled a recent morning when a mother and teenage daughter arrived carrying the exact amount in cash they were prepared to pay for the teen’s abortion.

The mother no longer had private insurance. They worried the procedure might cost more than the $470 they’d expected and carefully counted out.

“She didn’t have a dollar more,” Herron said.

A staff member ran the last name through a healthcare database and determined she was approved for Medicaid, explaining that the procedure was paid for.

The mom and daughter gasped in disbelief and then both burst into tears at the front desk window, returning home with the money later that day.

It’s the kind of scene Herron says she witnesses once or twice a week.

“When they find out that their Medicaid covers it, we’ve had some get emotional,” she said. “They cry, they say thank you, they’re very relieved. It’s one less burden they have and they’re very grateful for that.”

An earlier version of this story incorrectly stated that a lawsuit challenging House Bill 40 was pending in front of the Illinois Supreme Court. The case is pending before an Illinois appellate court.